Adults Preferred choices
Doxycycline, 100 mg orally twice daily†† Ciprofloxacin, 500 mg orally twice daily‡ Alternative choice Chloramphenicol, 25 mg/kg orally 4 times daily§** Children\ Preferred choice
Doxycycline,†† If >45 kg, give adult dosage If ,45 kg, then give 2.2 mg/kg orally twice daily Ciprofloxacin, 20 mg/kg orally twice daily Alternative choices Chloramphenicol, 25 mg/kg orally 4 times daily§** Pregnant women¶ Preferred choices
Doxycycline, 100 mg orally twice daily†† Ciprofloxacin, 500 mg orally twice daily Alternative choices
Chloramphenicol, 25 mg/kg orally 4 times daily§**
*These are consensus recommendations of the Working Group on Civilian Biodefense and are not necessarily approved by the Food and Drug Administration. See “Therapy” section for explanations. One antimicrobial agent should be selected. Therapy should be continued for 10 days. Oral therapy should be substituted when patient’s condition improves. IM indicates intramuscularly; IV, intravenously.
†Aminoglycosides must be adjusted according to renal function. Evidence suggests that gentamicin, 5 mg/kg IM or IV once daily, would be efficacious in children, although this is not yet widely accepted in clinical practice. Neonates up to 1 week of age and premature infants should receive gentamicin, 2.5 mg/kg IV twice daily. ‡Other fluoroquinolones can be substituted at doses appropriate for age. Ciprofloxacin dosage should not exceed 1 g/d in children. §Concentration should be maintained between 5 and 20 µg/mL. Concentrations greater than 25 µg/mL can cause reversible bone marrow suppression.35,62 \Refer to “Management of Special Groups” for details. In children, ciprofloxacin dose should not exceed 1 g/d, chloramphenicol should not exceed 4 g/d. Children younger than 2 years should not receive chloramphenicol. ¶Refer to “Management of Special Groups” for details and for discussion of breastfeeding women. In neonates, gentamicin loading dose of 4 mg/kg should be given initially.63 #Duration of treatment of plague in mass casualty setting is 10 days. Duration of postexposure prophylaxis to prevent plague infection is 7 days. **Children younger than 2 years should not receive chloramphenicol. Oral formulation available only outside the United States. ††Tetracycline could be substituted for doxycycline.